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Selective Parathyroid Hormone Venous Sampling in Patients with Persistent or Recurrent Primary Hyperparathyroidism and Negative, Equivocal or Discordant Noninvasive Imaging

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Abstract

Background

In patients with persistent (P-PHPT) or recurrent (R-PHPT) primary hyperparathyroidism, preoperative localization is important. Selective parathyroid hormone venous sampling (sPVS) is an invasive technique that can be used to regionalize and/or lateralize the source of PHPT when noninvasive imaging studies are nonlocalizing. The aim of the present study was to assess the role of sPVS in the preoperative evaluation of patients with P-PHPT or R-PHPT and negative, equivocal, or discordant noninvasive imaging localization.

Methods

After IRB-approval a retrospective review of all patients with P-PHPT or R-PHPT and nonlocalizing noninvasive imaging that underwent sPVS from 2000 to 2014 was performed. The location of the source of PHPT at sPVS was predicted by a parathyroid hormone (PTH) gradient and compared to the surgical, pathology, and biochemical follow-up data as the gold standard. Sensitivity and positive predictive value (PPV) were calculated.

Results

Of 30 patients who underwent sPVS, 12 patients did not undergo surgical exploration due to negative or non-localizing PTH gradient (n = 8) or opted for medical management (n = 4). Of the 18 patients who underwent surgical exploration, 17 (94 %) had a positive PTH gradient and pathologic parathyroid tissue identified at surgery. Sensitivity and PPV of sPVS were 93 and 77 %, respectively, for all surgical cases, 86 and 60.0 % for cervical cases (n = 11), and 100 and 100 % for mediastinal cases (n = 7). Sixteen patients (89 %) were surgically cured.

Conclusions

In patients with P-PHPT or R-PHPT and nonlocalizing imaging studies, sPVS is a sensitive test for localizing the source of PHPT when a positive PTH gradient is present.

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Authors and Affiliations

  1. Mayo Medical School, College of Medicine, Mayo Clinic 200 1st St SW, Rochester, MN, 55905, USA

    Philip Y. Sun

  2. Department of Radiology, College of Medicine, Mayo Clinic 200 1st St SW, Rochester, MN, 55905, USA

    Scott M. Thompson & James C. Andrews

  3. Division of Diabetes, Endocrinology and Metabolism, College of Medicine, Mayo Clinic 200 1st St SW, Rochester, MN, 55905, USA

    Robert A. Wermers

  4. Department of Surgery, College of Medicine, Mayo Clinic 200 1st St SW, Rochester, MN, 55905, USA

    Travis J. McKenzie, Melanie L. Richards, David R. Farley & Geoffrey B. Thompson

Authors
  1. Philip Y. Sun
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  2. Scott M. Thompson
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  3. James C. Andrews
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  4. Robert A. Wermers
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  5. Travis J. McKenzie
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  6. Melanie L. Richards
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  7. David R. Farley
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  8. Geoffrey B. Thompson
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Correspondence to Geoffrey B. Thompson.

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The authors report no potential or real conflicts of interest or financial support related to the content of this manuscript.

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Sun, P.Y., Thompson, S.M., Andrews, J.C. et al. Selective Parathyroid Hormone Venous Sampling in Patients with Persistent or Recurrent Primary Hyperparathyroidism and Negative, Equivocal or Discordant Noninvasive Imaging. World J Surg 40, 2956–2963 (2016). https://doi.org/10.1007/s00268-016-3621-z

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  • DOI: https://doi.org/10.1007/s00268-016-3621-z

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